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Are doctors assessing patients with hypertension appropriately at their initial presentation?
Siew Lee Stalia Wong1, Ping Yein Lee2, Chirk Jenn Ng3
1University of Malaya Primary Care Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Singapore Medical Journal
|October 10, 2015
Summary
Primary care doctors poorly assessed cardiovascular disease (CVD) risk factors in newly diagnosed hypertension patients. Over 15 years, clinical examination documentation decreased, while investigations increased, indicating over-reliance on tests.
Area of Science:
- Cardiology
- Primary Care Medicine
- Public Health
Background:
- Hypertension is a major risk factor for cardiovascular disease (CVD).
- Early assessment of CVD risk factors and target organ damage (TOD) is crucial for effective hypertension management.
- Primary care physicians play a vital role in initial hypertension diagnosis and risk assessment.
Purpose of the Study:
- To evaluate the extent of cardiovascular disease (CVD) risk factor assessment in newly diagnosed hypertension patients during their first primary care visit.
- To analyze the 15-year trend in CVD risk factor assessment for hypertension patients.
Main Methods:
- Retrospective study analyzing 1,060 paper-based medical records of hypertension patients.
- Systematic random sampling (1:4) to extract data on CVD risk factors, target organ damage (TOD), and diagnostic procedures.
- Data collected from the patients' first hypertension clinic visit.
Main Results:
- Assessment of CVD risk factors during the first hypertension visit was suboptimal, ranging from 5.4% to 40.8%.
- Documentation of TOD history (5.8%-11.8%) and related physical examinations/investigations (0.1%-63.3%) was limited.
- A declining trend in documented physical examinations contrasted with an increasing trend in ordered investigations over the study period.
Conclusions:
- Primary care physicians demonstrated inadequate assessment of CVD risk factors, secondary hypertension causes, and TOD during initial hypertension consultations.
- Observed trends suggest a shift towards prioritizing investigations over comprehensive clinical examinations in hypertension management.
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